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Malawi: Knowledge to curb the increase in traffic injuries
A final seminar for the project was held as a webinar in December 2020 with participants from five ministries, the police, road traffic organisers, hospitals and the National Institute of Public Health in Malawi as well as the press, the Norwegian Embassy and the Norwegian project group.
See the presentation: Road Traffic Injuries in Malawi with special focus on the role of alcohol. A collaboration between Kamuzu Central Hospital, Norwegian Institute of Public Health and Oslo University Hospital, Norway (pdf).
Background for the project
"Malawi is among the countries with the most road traffic fatalities in the world. Drunk driving is one of the problems, but to what extent we do not know because of the lack of alcohol testing and investigation," says Asbjørg S. Christophersen, senior researcher and project leader at the Norwegian Institute of Public Health.
The experienced researcher emphasises that more knowledge about road traffic injuries will highlight the problem and give the authorities an incentive to develop and implement preventive measures.
The project is in line with the UN's sustainability goal, section 3.6, which by 2020 aims to halve the number of deaths and injuries in the world caused by traffic accidents. In Malawi, traffic injuries crept up to 10th place in the ranking of causes of premature death in 2010, according to a study from the global burden of disease project, ref. figure below.
Collected basic information about traffic accidents
The idea of the project is that increased knowledge about traffic accidents will give attention and incentives to the authorities to start prevention.
The Ministry of Health in Malawi has recommended the project, which follows up on goals in Malawi’s health strategy and their recently approved national alcohol policy. In addition, the project follows up on the UN Sustainable Development Goal number three, which states that the number of global deaths and injuries from road traffic accidents shall be halved by 2020 – a goal that has not been reached and therefore is suggested postponed till 2030.
The project received grants from the World Bank in 2017, and the planning and preparation has taken a long time. Only at the end of May 2019 could they start recruiting patients.
Traffic-injured patients (18 years or older) were informed of the project as they arrived at the emergency ward at Kamuzu Central Hospital, project partner and the largest public hospital in Malawi. After being informed in English or the local language Chichewa, patients were then asked if they would like to participate in the project.
Two young doctors at the emergency unit at Kamuzu measured the alcohol levels in the patients and registered this information in a form on iPad, developed for the project, in cooperation with the Norwegian project group and the group at Kamuzu.
The hospital wants to build a database with basic information about adult patients who are admitted with injuries from road traffic accidents.
The doctors collected detailed information about the accident; the type of road through Google Maps; if it occurred in a rural or urban area; when the accident occurred; if it happened on a weekday or weekend; the type of vehicle involved; age and gender of the patient; if the patient was a driver, cyclist, passenger or pedestrian; the severity of the injury; and the alcohol level at admission.
The data were depersonalised before registered in the iPad programme.Experts from the Norwegian Institute of Public Health and Oslo University Hospital are supervisors (see text box).
High participation rate
In about three months, 1347 traffic-injured patients were asked to participate in the project. Of these, 88 refused to participate, which mean that the result was a participation rate of 93.5. Of those, 19.2 percent were women.– The high percentage of participants is particularly gratifying since the project was predicted low interest before we started the collection, as it was alcohol we should measure, says Asbjørg S. Christophersen.
Passengers is the largest patient group
The largest patient group was passengers (36%), followed by pedestrians (17.6%), cyclists (14.6%), motor vehicle drivers (14.5%), motorcyclists (12%), and a smaller group where the type of road user did not stay registered (about 5%).
Men and pedestrians more often influenced by alcohol
Alcohol was detected in 25.9% of men and only 2.5% of women. Alcohol was most common in the age group 26–34 years (25.6%) and in pedestrians (41.8%), followed by motorcyclists (24%), car drivers (23.8%), bus / minibus / lorry drivers (20, 8%), passengers (19.8%) and cyclists (19.1%).
Higher alcohol levels at weekend nights
Most dangerous and highest alcoholic occurence was detected at weekend nights (00.00 - 06.00) in 58.3%, and 36.8% in the afternoon / evenings (18.00 - 24.00). In the afternoon / evening on regular weekdays (18.00 - 24.00), alcohol was detected in 34.4%.
Publishing of data
Three articles are submitted for publication in various international journals, of which two are accepted, one of them published (see references below), and the third under review. Two more articles are being planned.
Received the Robert Borkenstein Prize
The Norwegian Public Health Institute received the Robert Borkenstein Prize awarded to Asbjørg S. Christophersen at the ICADTS (International Council on Alcohol and Drugs and Traffic Safety) conference in Edmonton, Canada, in 2019, for the implementation of the project. The prize is only awarded every three years.
Follow-up delayed due to COVID-19
A seminar in Lilongwe scheduled for early autumn 2020 was canceled due to the COVID-19 pandemic. Instead, the World Bank branch in Washington DC invited to a virtual seminar on December 9 where the results were presented for representatives from five Malawian ministries as well as the police, the Directorate of Road Traffic and Safety Services, the Public Health Institute of Malawi, Kamuzu Central Hospital, Queen Elizabeth Central Hospital, Malawi Alcohol Policy Alliance, researchers, students, the press, the Norwegian Embassy and the Norwegian project group. The project coordinators from Kamuzu presented the results and the project leader laid out the project preparations and recommendations for traffic safety measures.
-It was a successful seminar – also purely technical, which was definitely a concern, says project leader Asbjørg S. Christophersen. -We received a lot of praise from the World Bank and others. There were several questions from Uganda and South Africa, among others, who want to do something similar.
A prerequisite for knowledge-based policy
The results will provide the governmental authorities in health, transportation and justice with particularly valuable information to shape a knowledge-based policy to improve road safety and create effective information campaigns. Christophersen refers to a poll that found that the 0.8-alcohol legal limit in Malawi for driving a motor vehicle is little known to people.
− A reduction in traffic accidents could save Malawi health care resources, save lives and tragedies because individuals become disabled and destroyed for the rest of their lives.
This is the first time that the Norwegian Institute of Public Health has received project funding from the World Bank, through the Global Road Safety Facility, a multi-donor fund, established to assist authorities in the LMIC in developing a road traffic safety plan. The international organisation ICADTS (International Council on Alcohol Drugs and Traffic Safety) and the Norwegian Council for Road Safety have also contributed. The Church Aid’s local office in Lilongwe has been responsible for disbursements in Malawi.
Chifundo Kajombo – project coordinator, KCH
Mads Sundet M, Chifundo Kajombo, Gift Mulima, Stig Tore Bogstrand, Carlos Varela, Sven Young, Asbjørg S. Christophersen, and Hallvard Gjerde: Prevalence of alcohol use among road traffic crash victims presenting to a Malawian Central Hospital: a cross-sectional study. Traffic Injury Prevention, 2020. https://doi.org/10.1080/15389588.2020.1819990
Christophersen AS, Mørland J, Stewart K, Gjerde H. 2016. International Trends in alcohol and drug use among motor vehicle drivers. Forensic Sci Rev. 28(1):38–66.
World Health Organization. 2018a. Global status report on alcohol and health 2018. Geneva, Switzerland: World Health Organization.
Dräger Alcotest 5820, Drägerwerk AG & Co., Lübeck, Germany.
Q.E.D.® A150, Orasure Technologies, Inc., Bethlehem, PA, USA.
Eide AH,,Braathen S, Azalde G, Munthali A, Chiocha M, Ndawala J, Natvig H, Hoel E. Fighting poverty alcohol misuse prevention in Malawi – revised summary report (December 2013) SINTEF Technology and Society, 2013–12 -16.
Traffic injuries in the world
Nearly 1.3 million people die each year in road traffic accidents
20–50 million people are injured in traffic accidents each year
90 per cent of accidents occur in low and middle-income countries even though they only have 50% of the car fleet
Road traffic accidents are among the three leading causes of death between the ages of 5 and 44 years
- Unless effective safety measures are introduced soon, road traffic accidents will become the fifth largest cause of deaths globally and the number of deaths will increase to 2.4 million per year
Source: World Health Organization